1. Please enter your information:

First Name:
Last Name:
Phone #:	- -  ext
Company:
URL:
Email:
	I was previously contacted by an Adsdaq Adviser

2a. What is your average monthly advertising spend online?
[Monthly Spend?] 0-$100 $101-$999 $1,000 - $4,999 $5,000- $10,000 $10,000-$50,000 $50,000+ I'd rather not say

2b. Where are you spending your online advertising budget?

	Google AdWords		Yahoo! Search Marketing
	MSN		Valueclick
	AdBrite		RightMedia
	Other

3. Do you use a third party ad server?
Yes, I use an ad server.
No, I do not use an ad server.

4. If you are chosen to participate in the beta, would you be willing to speak with our product development team to provide us with your feedback and recommendations on ADSDAQ Buying Desk?
Yes, I would participate in a 30 minute phone call with the product development team.
No, I would not participate in a 30 minute phone call with the product development team.

5. Provide us with your contact preferences:
Yes, I'd like to receive emails about future ADSDAQ news.
Yes, you can contact me by phone about the ADSDAQ beta program.